缺血性脑卒中后便秘相关因素的分析评价及护理

Constipation after ischemic stroke: Risk factors and nursing measures

目的:探讨缺血性脑卒中后便秘发生的主要危险因素及护理干预效果.方法:将华中科技大学同济医学院附属梨园医院收治的60例脑卒中后便秘患者和60例脑卒中后非便秘患者分别作为实验组和对照组,比较两组患者相关因素差异,实验组患者给予综合护理干预,观察实验组患者干预前后便秘症状评分、简易智能精神状态检查量表(minimental state examination,MMSE)评分、Barthe生活指数(Barthel index,BI)评分及改良Rankin量表(modified rankin seale,MRS)评分变化情况结果:实验组患者急性期、偏瘫、使用脱水剂、鼻饲饮食比例以及MRS评分均明显高于对照组[(70.00%vs 41.67%)、(66.67%vs30.00%)、(56.67%vs 25.00%)、(21.67%vs8.33%)、(4.02分±0.86分vs 3.10分±1.22分)],差异具有统计学意义(P<0.05或P<0.01)实验组MMSE评分、BI评分及排便时间固定比例均明显低于对照组[(25.91分±3.22分vs 28.30分±2.51分)、(44.41分±23.35分vs90.06分±15.21分)、(30.00%vs 75.00%)],差异具有统计学意义(P<0.05或P<0.01);实验组患者干预后便秘症状评分和MRS评分均明显降低[(2.91分±2.33分vs 11.10分±1.83分)、(2.93分±1.17分vs 4.02分±0.86分)],MMSE评分和BI评分均明显升高[(28.36分±2.40分vs 25.91分±3.22分)、(89.69分±13.28分vs44.41分±23.35分)],与干预前比较,差异具有统计学意义(P<0.01).结论:缺血性脑卒中急性期、偏瘫、使用脱水剂、鼻饲饮食、排便时间不固定、认知功能障碍、日常生活活动能力降低以及生活质量下降均为诱发便秘的主要危险因素,采取针对性综合护理干预措施临床效果显著,具有较高临床推广价值.

AIM： To explore the risk factors for constipation after ischemic stroke and the nursing measures. METHODS： Sixty patients with constipation after ischemic stroke and 60 patients without constipation after ischemic stroke were included in an experiment group respectively. Risk factors and a control group, for constipation after ischemic stroke were analyzed by comparing the two groups. The experiment group received comprehensive nursing intervention. The consti- pation symptom score, mini-mental state exami- nation （MMSE） score, Barthel index （BI）, modi- fied Rankin scale （MRS） score were compared between the two groups. RESULTS： The frequencies of acute stage, pa- ralysis, use of dehydration, nasal feeding and MRS score in the experiment group were sig-nificantly higher than those in the control group （70.00% vs 41.67%, 66.67% vs 30.00%, 56.67% vs 25.00%, 21.67% vs 8.33%, 4.02 ± 0.86 vs 3.10±1.22; P 〈 0.05 or P 〈 0.01）. MMSE score, BI and rate of regular defecation in the experiment group were significantly lower than those in the control group （25.91 ± 3.22 vs 28.30 ± 2.51, 44.41± 23.35 vs 90.06 ± 15.21, 30.00% vs 75.00%; P 〈 0.05 or P 〈 0.01）. In the experiment group, the constipa- tion symptom score and MRS score were signifi- cantly lower （2.91± 2.33 vs 11.10 ± 1.83, 2.93 ± 1.17 vs 4.02 ± 0.86; P 〈 0.01）, and MMSE score and BI were significantly higher （28.36 ± 2.40 vs 25.91±3.22, 89.69 ±13.28 vs 44.41± 23.35; P 〈 0.01） after intervention than before intervention. CONCLUSION： The major risk factors for con- stipation after ischemic stroke are acute stage, paralysis, use of dehydration, frequent nasal feeding, irregular defecation, cognitive disorder, decreased daily activities and decreased quality of life. Interventional measures have significant effects in reducing constipation after ischemic stroke.